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Kenneth Perlmutter, Ph.D. - Guest
Kenneth Perlmutter, Ph.D. Founder of the Family Recovery Institute and a licensed psychologist specializing in Family Systems, has 35 years of experience working with complex psychological and behavioral health disorders. In 2008 he founded The Family Recovery Institute to provide multi-disciplinary treatment for individuals and families including dynamic therapy, family systems work, group therapies, healing workshops and clinician training. He has pioneered and validated a theory of family system woundedness with a corresponding recovery model he calls Stress-Induced Impaired Coping. He wrote the book Freedom from Family Dysfunction: A Guide for Families Battling Addiction or Mental Illness specifically for family members who love someone battling addiction or mental illness but “want to break the cycles of codependency and relapse plaguing their dysfunctional systems.” He has overseen the design and installation of the family treatment program for Bayside Marin, Morningside Recovery, Safe Harbor Treatment Center for Women, Casa Capri/Windward Way and other national-level programs. In addition, he conducts a twice-monthly therapy group for parents of troubled teens and stuck young adults and has historically conducted several healing workshop for families of the White Mountain Apache Reservation in Whiteriver, AZ. As a professional educator, he has served on the graduate faculty for San Francisco State University’s Counseling Department and as Associate Professor of Chemical Dependency Studies at Cal State East Bay. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton Psy.D. (01:35):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton Psy.D. (02:19):
Today I'll be speaking with Dr. Kenneth Perlmutter, who is the founder of the Family Recovery Institute and a licensed psychologist specializing in family systems. He has 35 years of experience working with complex psychological and behavioral health disorders. In 2008, he founded the Family Recovery Institute to provide multidisciplinary treatment for individuals and families, including dynamic therapy, family systems, work group therapies, healing workshops, and clinician training. He has pioneered and validated the Theory of Family System woundedness with a corresponding recovery model he calls stress induced impaired coping. He wrote the book, Freedom From Family Dysfunction, A Guide for Families Battling Addiction or Mental Illness, specifically for family members who love someone battling addiction or mental illness, but want to break the cycles of codependency and relapse plaguing their dysfunctional systems. He is overseeing the design and installation of the Family Treatment Program for Bayside Marin, Morningside Recovery, Safe Harbor Treatment Center for Women, Casa Capri, Windward Way, and other national level programs. In addition, he conducts a twice monthly therapy group for parents of troubled teens and stuck young adults and has historically conducted several healing workshops for families of the White Mound Apache Reservation in White River, Arizona. As a professional educator, he has served on the graduate faculty for San Francisco State University's counseling department, and as associate professor of Chemical Dependency Studies at Cal State East Bay. Let's listen to the interview.
Keith Sutton Psy.D. (03:48):
Well, hi, Kenneth. Welcome. Thanks for joining us.
Kenneth Perlmutter, Ph.D. (03:50):
Thanks a lot for having me, Keith.
Keith Sutton Psy.D. (03:52):
Yeah. So Kenneth, I know you. You're one of local here in Marin, in San Rafael as a therapist who does a lot of work with addiction, substance abuse. You work with families, you have your Family recovery institute. And so I wanted to learn more about the work that you're doing and particularly too around the family systemic work and, and addictions. But first I always like to find out about how people kind of got to doing what they're doing, their evolution of their thinking
Kenneth Perlmutter, Ph.D. (04:26):
Of my thinking or becoming a therapist, or both?
Keith Sutton Psy.D. (04:28):
Both. Yeah. What, wherever. Yeah.
Kenneth Perlmutter, Ph.D. (04:31):
Well, I was going to go to medical school and became persuaded. I was too scared of blood and needles.
Kenneth Perlmutter, Ph.D. (04:40):
I had poor guidance and would've been told, oh, half medical school students pass out during many of their initial procedures. We'll get you through it, but I didn't know that. So I switched to creative writing and journalism. because I was really strong in all that. And by the way, for any of you therapists working with parents who have kids that don't know what major, I highly recommend journalism as a major or a minor. It teaches you how to organize complex material, how to think, how to interview people, how to overcome social anxiety about introducing yourself. It was a great start.
Kenneth Perlmutter, Ph.D. (05:19):
And then I found myself in the world of San Francisco advertising in the eighties, which was a pretty wild ride in a lot of ways. And so I sought out a therapist who helped me a lot get through that, and I thought he had a pretty cool lifestyle and approach to things. And I thought maybe I could do that. That might be better. So I started going to graduate school at night, got a doctorate and a master's degree, not in that order. Still worked in advertising because I was pretty dependent on the income.
Kenneth Perlmutter, Ph.D. (05:55):
But in around 1989, I got an internship. I thought I was going to be a psychoanalyst because I really appreciated the down and in kind of thinking all the ideas about human development through the lens of the inner world. My school was very psychoanalytically oriented, and I got a practicum position and brand new therapist, first ever therapist position with what proved to be a very sophisticated agency that was psychoanalytically informed. It was called the Boyer House. And even though it was supposed to be a one academic year unpaid position, they hired me about halfway through that to work in the milieu, like as a counselor. And I ended up staying 14 years and becoming the clinical milieu director, the director of admissions, and similar.
Kenneth Perlmutter, Ph.D. (06:47):
So it was that first therapist, his name was Joe Riley in San Francisco in the eighties, who gave me the inspiration to want to move more into being a therapist. So in my second year, I'd say at, at Boyer House, I somehow got placed on the family therapy team, which I liked because the whole down and in three, four times a week, seeing one person, or seeing a small string of people that often, didn't seem to fire me up, as well as being in a room like with, you know, a dad and a mom and two teenagers and, you know, other family members perhaps. And the energy and the emotion and the challenge associated with engaging, you know, all those members endeavoring to appear and be neutral just really seemed to work a lot better for my personality and my thinking.
Kenneth Perlmutter, Ph.D. (07:52):
Though, I remained I don't know if you could say a devotee, and I am, to this day, my work is still heavily informed by psychoanalytic thinking, meaning thinking about the unconscious, the inner world, transference, countertransference and the nature of relating particularly therapist, client relating, therapist, family relating. And I help families look at how they relate to each other, of course, how they relate to their communities, like how they imagine they're seen or would like to be seen, how they relate to their ancestry, to their ancestors, you know, and how they picture those three ways of relating, informing their approach to the future and the present, of course. And so that's a big part of, that's an important way of thinking about how I think.
Kenneth Perlmutter, Ph.D. (08:59):
We do get thought of a lot at the Family Recovery Institute as being focused largely, or even primarily on substance use and addiction. And while we have a lot of expertise in that, including the personal recovery of quite a few of the staff members. I don't think of us as a substance abuse or addiction clinic. I think of us more as a full service mental health clinic with a lot of expertise in substance abuse and addiction recovery, trauma related disorders. And I might be jumping ahead, but we really specialize in working with families that have a member with more significant psychological or behavioral disturbance. And many therapists send me those families because they don't want to work with them. You know, like a narcissistic alcoholic father as an example. Or you know, a bipolar 30-year-old who's been creating havoc since high school in the family. And we'll work with individuals in the family, the family itself, any one member at the level of thinking about the family. But that's a way really for therapists to think about us. Think of Kenneth Perlmutter and his team for those more disturbed, more chaotic families, sometimes high conflict divorce. It's not a specialty, but we get a lot. And because we're a small team, we can divide and conquer a little bit, if you will. Like, the ideal package is, you should interrupt me, by the way, if I'm going-
Keith Sutton Psy.D. (10:53):
No, no, this is, yeah. Yeah. Keep going.
Kenneth Perlmutter, Ph.D. (10:56):
You know, the ideal package we would offer to someone, well, let me back up. Here's our most common referral. I got one last week. The mom calls, I have a 20-year-old son who's been away at college. And we just found out he went to no classes whatsoever his most recent semester. He lied about that. It was only when we happened to see a grade report or a letter about being on probation or something that we learned all this. He's been home now, what is it? October. He's been home now since the end of May. He smokes and uses cannabis pretty much daily. He was working for a time at Trader Joe's, Costco, Home Depot. Starbucks, whatever it might be. These are, I don't mean pejoratively in any way. But he, you know, was late too often and he lost the job, or he hated it and he quit. He doesn't want to go back to school. He didn't want to go back to school three weeks ago when it resumed at ASU, SMU, BU, SFSU, it doesn't matter where, right. And can you, can you straighten him out?
Keith Sutton Psy.D. (12:16):
Yeah. Okay, great. Well so there's two big pieces that I'm super interested in here that I'm thinking about. One particularly is the integration of kind of family therapy or family systems work and psychoanalytic. Because sometimes the, oftentimes, I know a lot of folks that are more, sometimes psychoanalytic or psychodynamic don't necessarily work as systemically because it can kind of affect the transference, the counter transference and kind of shift the frame of the therapy. So I'd love to hear about your kind of work within that or your influences in that kind of working systemically and analytically.
Kenneth Perlmutter, Ph.D. (13:00):
Well, that's a really important observation that you're making. So there isn't an effort, per se, in the family systems work to maintain a pure kind of tableau rasa projective screen onto the therapist, as you would find in a more traditionally psychoanalytically informed psychotherapy. Rather, I use my psychoanalytic training and some of the concepts to help me think about attachment, the nature of attachment, the stage of family development in which the family presents, you know, that they're occupying at the time. And in that way, it's a psychoanalytically informed systemic work. But it probably draws more directly on my own personal experience with my own family since 1989, my own wounded family system, and how it has functioned or dysfunctioned. Attachment theory systems notions, like what is a system? How does a system function? How do members influence the system? How do we affect each other? What do we need from each other? How are crises managed? What's the nature of privacy? So I think to call it psychoanalytic family work wouldn't be very accurate. Though, there is a strong movement for psychoanalytically informed or psychoanalytic couples work. In fact, there's an organization in the Bay Area that specializes in it, PCPG, Psychoanalytic Couples Psychotherapy Group, and they offer trainings as well.
Keith Sutton Psy.D. (14:56):
Great
Kenneth Perlmutter, Ph.D. (14:57):
Intensive training in couple work that's psychoanalytically. Yeah. That is psychoanalytic.
Keith Sutton Psy.D. (15:05):
Nice. And tell me a little bit about the family development and where they are in their developmental period. Is that more like state kind of a lifecycle kind of-
Kenneth Perlmutter, Ph.D. (15:20):
That's probably a, yeah, that's probably a fair way to think about it.
Keith Sutton Psy.D. (15:23):
Yeah. Like whether, you know, young children or adolescent or, you know, kind of empty nest, like those kind of stages.
Kenneth Perlmutter, Ph.D. (15:31):
Yes, exactly.
Keith Sutton Psy.D. (15:33):
Got it.
Kenneth Perlmutter, Ph.D. (15:34):
Yeah. Exactly. Because, you know the the nature of intervention and solution for, you know, parents who had not long ago of, you know, an oppositional and very intelligent 12-year-old or 11-year-old who has a superstar, 13-year-old older sibling, are going to be, it's a very different kind of conversation and set of interventions, than let's say for parents approaching 60 who have a 35-year-old, you know, highly problematic dependent child -- adult child.
Keith Sutton Psy.D. (16:16):
Sure. Definitely. Yeah. Now look-
Kenneth Perlmutter, Ph.D. (16:21):
Can I say one more thing about, a lot of the work looks at the nature of dependency in the system, and I don't mean chemical dependency, though that's not ignored when it's part of the deal, but I see families that experience dependency, and I wrote a lot about this in my book that can be described in one of three forms. So families come with problematic offspring, that's what we call them problematic offspring. Because that covers all genders, all diagnoses.
Keith Sutton Psy.D. (16:56):
Yeah.
Kenneth Perlmutter, Ph.D. (16:57):
You know, and everything in between. So we have exaggerated dependency, we have hostile dependency, and there's chronic dependency. And probably the most common form is the exaggerated dependency, which basically is kind of what it connotes a situation where a child of any age, depends on the parents or expects the parents and the parents comply to provide things and do things for that child. And I'm just going to say child. I've had four or five families where the kid is in their fifties. Not common. Typically, the kids are 16 to 30 or a little older typically, in which the parents have been performing functions and fulfilling needs of the child that the child could fulfill for themselves. And as a result of this exaggerated dependency, everyone gets caught that much deeper in this kind of systemic goo that keeps members stuck and keeps parents believing that they have to provide these things, lest there be some calamity or catastrophe that they couldn't bear.
Keith Sutton Psy.D. (18:19):
Yeah.
Kenneth Perlmutter, Ph.D. (18:20):
And it works very well for the kids who are caught in exaggerated dependency for their parents to believe, well, we can't just cut him off. Although for the record, we never advocate cutting anyone off. Or anything like so-called tough love.
Keith Sutton Psy.D. (18:35):
Yeah.
Kenneth Perlmutter, Ph.D. (18:37):
But this is probably the most common form.
Keith Sutton Psy.D. (18:39):
So it's kind of like sometimes what people talk about as sometimes that enmeshment or an, you know, enabling that might be happening.
Kenneth Perlmutter, Ph.D. (18:46):
Yeah. I think enabling
Keith Sutton Psy.D. (18:47):
As trying to support their children and care for their children. But sometimes, yeah, the anxiety leads to, you know, over accommodation and reinforcing avoidance and potentially enabling in as a byproduct.
Kenneth Perlmutter, Ph.D. (19:00):
Yeah. It's probably more enabling than the former term term that you used
Keith Sutton Psy.D. (19:05):
Rather than enmeshed.
Kenneth Perlmutter, Ph.D. (19:06):
Yeah. I think of enmeshment as more an emotional condition, which you can have with or without the enable. Though I think probably you know, the syllogism would be all enablers are enmeshed. Yeah.
Keith Sutton Psy.D. (19:22):
Okay.
Kenneth Perlmutter, Ph.D. (19:23):
We talk about enabling in its most destructive form, is that which is unconscious. Meaning it's not really thought about. The parent doesn't wonder, well, what would be the, what's the effect of my providing this again on me? That's the last question they'll ask me--the parent, on my kid or on the system. Right. Yeah. And what's the effect of me providing this, again, on the nature of dependency in the system? And once I help people start to just wonder that, like, we never tell people, don't give them any more money or, you know, don't let 'em use the car or, you know, cut them off or change the locks or anything like that. Though at times, parents do the work and they conclude we can no longer live together in a way that supports our parental serenity, safety, security, or quality of life.
Keith Sutton Psy.D. (20:26):
Yeah.
Kenneth Perlmutter, Ph.D. (20:27):
What's true in most families is that when the parents show up for help and the kid can be anywhere from 15 to 50, they have not placed sufficient emphasis on their own needs. It's kind of like classic codependency, if you will. Thinking of the effect on me comes last.
Keith Sutton Psy.D. (20:50):
Yeah. That kind of sacrificing and just trying to help the kids or do something, you know, to take care of the kids, but not necessarily consciously thinking about is this really helping them in the long run, and is this helping me or is this really kind of for benefit of our long-term health.
Kenneth Perlmutter, Ph.D. (21:09):
Well, sometimes the evidence is in, and it's pretty patent that I, the parent, am not going to be able to, certainly not going to be able to change my kid. Most parents come expecting or, or having, attempted to get relief for themselves by changing their kid. . Or their kid's behavior, or their kid's beliefs or their kid's attitudes. And usually by the time the kid is 20, 25, 30, 35, 40, the evidence is irrefutable that the parents are not going to be able to change the kid. So we immediately start talking about pursuing solutions for the parents that are not conditional on the kid being different, though again, without anything like, kick him out, you are dead to me or any other similar, you know, Robert De Niro-esque kind of drama.
Keith Sutton Psy.D. (22:04):
Yeah. So, so shifting their focus away from like, change my kid, or what can I do to change my kid to what can we do to help change your situation?
Kenneth Perlmutter, Ph.D. (22:15):
Our situation, yes.
Keith Sutton Psy.D. (22:17):
Our situation
Kenneth Perlmutter, Ph.D. (22:18):
And in my method, which I've been practicing a long time now, of all the things parents can do to attempt to change their kid when they make the shift, the hierarchical emphasis toward their own needs as the parents, they create the conditions under which it's most likely their kid will move more in the direction they've always wanted. It's a bit paradoxical, but I see it. Over and over and over and over and over. And again, this is not tough love, this is not. Tough love equals tough stake and equals parental misery.
Keith Sutton Psy.D. (22:56):
Sure. Tell me a little bit about some examples of that, as you're kind of helping them shift in that hierarchy or shift their focus. What does that look like and how, because I know that, you know, oftentimes I think that sometimes as people try to encourage parents, for example, to do self-care or something the parent's like, yeah, yeah. You know, when the kid's like out of the house, I will. But right now, like their so focused is on the kids and kind of, you know, really pushing their needs aside. What does that look like? And I know it's probably also different in this situation where they're after 18 or so on and have expected maybe to have been launched, but they're not.
Keith Sutton Psy.D. (23:38):
And I also really want to point out that it's great that you are working with the families over 18, because I think a lot of people get stuck in, oh, this kid's over 18, so I can't do any of the family work. But ultimately that's where so much of the power is, especially like this situation you're talking about. I oftentimes get that too. Yeah. Bombed outta school, home smoking weed, playing video games until five in the morning. You know, maybe they're taking a class or two at community college, but they show up half the time and keep dropping all their classes. And as parents, you know, that, they can still also be helpful and, and sometimes they're unknowingly, like you're saying, kind of enabling in a way that's not necessarily helping support with the kids' success, but really, oftentimes the parents are the key to helping create that shift. Sometimes the kids are so depressed or just doing so much, smoking weed or whatever it might be that they're not really that motivated for change,
Kenneth Perlmutter, Ph.D. (24:37):
Especially if you have your parents, you know, taking care of most of the things you need. What would be the motivator to change? There might be some internal motivation.
Keith Sutton Psy.D. (24:47):
Yeah. But especially if they're in patterns of avoidance where they're just like not wanting to deal with
Kenneth Perlmutter, Ph.D. (24:52):
Yeah. That's a good way to say it.
Keith Sutton Psy.D. (24:53):
Right. And they're just like, so, yeah. So back to this idea of kind of shifting the parents with their focus on their needs and kind of prioritizing their place in the hierarchy of the family system. What does that look like, or how are parents reacting to that as you're encouraging them to do that?
Kenneth Perlmutter, Ph.D. (25:12):
Tentatively, is how they react to that. I think the most common approach in that regard, is to help a parent identify their own, their behaviors, that reinforce or continue the conditioning of the exaggerated dependency. And so before I jump to that, let me just describe another common form of the dependency which is what we call hostile dependency. And, again, it's kind of what you would think it connotes. In hostile dependency, the child depends on the parents and is also assaultive to the system. Let's say, he may be belligerent, he may steal, he will put at risk the family's resources or squander them, and or reputation. And it can be as blatant, you know, and as frightening as physical violence in the home, throwing things, breaking things, verbally assaulting his parents, or her siblings, or I guess self-harm can maybe come in this category, but it doesn't fit as tightly.
Kenneth Perlmutter, Ph.D. (26:37):
And so we start there with an examination of how the parents respond to the hostility, because in the method, kind of in a DBT sort of way, we place assaults on the family system or on any of its members. At the top of the hierarchy in terms of what requires intervention. Kind of like a DBT client calls her therapist during the week because she's going to cut herself and has helped with a tool and avoids cutting, comes in for session and wants to talk about a boy she met on Bart. And the DBT therapist will say, well, we could talk about this kid, Aaron, you met on Bart, but first we need to talk a little bit about the phone call we had the other day when you were thinking very seriously about cutting yourself again.
Kenneth Perlmutter, Ph.D. (27:34):
So in hostile dependency, we look at the parents' behaviors that basically tolerate the hostility and make it possible for it to continue. And all these parental behaviors, or even it can be sibling behaviors too, are probably caught up in one of the following actions. And you don't know me that well, but I like alliteration. They all start with letter S.
Keith Sutton Psy.D. (28:09):
Okay.
Kenneth Perlmutter, Ph.D. (28:10):
So we have serving, soothing, saving, smoothing, solving, sacrificing, sobbing. You know, that probably will, can always come up with a few more when we rattle off the list.
Keith Sutton Psy.D. (28:28):
Sure.
Kenneth Perlmutter, Ph.D. (28:28):
When-- so, I help a parent identify which of these, you know, they most common events, you know, do you tend to like, try to, you know, make him feel better? Do you anticipate your kids' needs and attempt to serve them? Do you smooth over the details of their lives by reminding them of appointments? Some of these aren't wrong. Don't, I'm just spitballing here.
Keith Sutton Psy.D. (28:56):
Sure, sure.
Kenneth Perlmutter, Ph.D. (28:57):
You know calling their bosses for them, you know, what do you give up in order to provide for your kid? That would be the sacrificing, you know, how caught are you in solving, you know, the bigger questions in their life. And once we get a shorter list of a particular family's behavioral patterns, then we would intervene gently on those. Often with a question like, well, tell me your idea, your fantasy of what would happen if you didn't do that. Like for five minutes, even.
Keith Sutton Psy.D. (29:40):
Ah, yeah.
Kenneth Perlmutter, Ph.D. (29:42):
Seriously. Sometimes it comes down to that.
Keith Sutton Psy.D. (29:45):
And is this conversation with the child or young adult present, or is this with the parents separately, or does it-
Kenneth Perlmutter, Ph.D. (29:52):
That's a great question. Typically I start with just the parents. But I say to them, if you all are ready to talk together from the get go, and just this morning a dad said, I suggested the parents come in, one of them couldn't make the time, the dad said, I'm just going to come with our son or daughter. I don't even remember. And I, I had already told them, you know, because they wanted to come in together. I said, if you know you're ready to start talking together, that's fine. I would probably, in any case, split them up some of the time. I definitely like meeting with the kids in addition to meeting with the parents, and when there's an IP, everybody knows what that is, in the kid group, I always try to make it that I meet with the parents and then I meet with all the kids. So that they're to reduce the whole IP focus.
Keith Sutton Psy.D. (30:56):
Yeah. The identity patient. Yeah.
Kenneth Perlmutter, Ph.D. (30:57):
Yeah. Sorry, I should've defined it. Yes. Right. Because I tell them this is not a forum for straightening out Jimmy or Jessica. Sure. The forum for looking at how our system functions, how we each are participating in the deal with each other. And to talk about what we know we want more of or less of from each other and for ourselves in our lives as members of this family.
Keith Sutton Psy.D. (31:24):
Yeah.
Kenneth Perlmutter, Ph.D. (31:25):
That helps a lot with the IP because they're so used to, you know, coming in with their parents and then dad rattles off the list of medications since he was 12 . And mom talks about all the heartbreak she's experienced, you know, and the kid watches and listens or doesn't and sits there and it's just more of the same. Yeah. So I do a lot of work to try to have a different kind of conversation than the one they've had in the past with other therapists.
Keith Sutton Psy.D. (31:58):
Sure.
Kenneth Perlmutter, Ph.D. (31:58):
Or, and certainly with each other, but a lot of what I'm saying to you today. I would say in the kids' presence. Yeah. I think virtually everything that I've said today, I would say. Depending on, you know, the kid's willingness to just comport themselves in a way so that we could have a conversation. Yeah.
Keith Sutton Psy.D. (32:19):
Yeah. Definitely. Okay. So, and this is this piece about kind of shifting again, the hierarchy, kind of the parents you know, looking at their needs, I guess. And then particularly in this case, in the assaultive kind of dependent situation, really kind of prioritizing, you know, addressing those issues. And you're going through these serving, soothing, saving, solving, sacrificing, sobbing and so on, to really kind of look at how they might be engaging in this, and then you're kind of having them be curious around it. And just really bringing that more to consciousness and also potentially shifting that. And that's kind of more of the way of going towards the parents' needs.
Kenneth Perlmutter, Ph.D. (33:09):
Yeah.
Keith Sutton Psy.D. (33:09):
Of basically engaging in that lesson and being able to do, I guess other things or so on or not be so caught up in, in trying to save or solving or so on.
Kenneth Perlmutter, Ph.D. (33:23):
What would it be like to conclude you aren't able to solve and serve and smooth for your kid? What's in the way of recognizing that the data of your lives adds up to that?
Keith Sutton Psy.D. (33:41):
Yeah.
Kenneth Perlmutter, Ph.D. (33:41):
But really asking that, not, you know, as a rhetorical question. Like, what the hell's wrong with you? Why can't you just see and face it? But really instead, like, what would that mean? Because it usually means a lot of grief.
Keith Sutton Psy.D. (33:55):
Yeah.
Kenneth Perlmutter, Ph.D. (33:56):
Parents have lost the idealized version or vision of their kid that they had, you know, from kindergarten. And many, many of my kids, we could call them, are on paths that have diverged dramatically from, you know, kindergarten to middle school to high school graduation, to college, to some kind of, some version of independent living.
Keith Sutton Psy.D. (34:26):
Yeah.
Kenneth Perlmutter, Ph.D. (34:26):
And sometimes that divergence is dramatic and kind of heartbreaking.
Keith Sutton Psy.D. (34:32):
Yeah.
Kenneth Perlmutter, Ph.D. (34:33):
And we honor that. And once we make room for a little bit of that grieving, family members may find it easier to make some shifts in their own behavior.
Keith Sutton Psy.D. (34:47):
Sure.
Kenneth Perlmutter, Ph.D. (34:49):
Because after all, isn't that what we can control more than anything else, is like what we do?
Keith Sutton Psy.D. (34:53):
Yeah. Our side of the street. Right?
Kenneth Perlmutter, Ph.D. (34:54):
Yeah.
Keith Sutton Psy.D. (34:55):
Yeah. Definitely. Now do you want to speak a little bit about the chronic dependent position?
Kenneth Perlmutter, Ph.D. (35:02):
Yeah. Okay. So the third form is chronic dependency, and that's where, you know, your kid of any age has a, you know, maybe lifelong or long lasting mental illness or learning disability or some other kind of impairment, that we have to find some acceptance for, and then titrate the caregiving and the sacrificing that we do for that person that recognizes and matches their chronicity, if you will. You know, I was just meeting with two sisters who have a third sister, who has a 32 year-old son with pretty significant, pretty severe schizophrenia. And for those of you familiar, which is most therapists, schizophrenia is just a heartbreaking, tragic illness, especially in its more severe forms.
Kenneth Perlmutter, Ph.D. (36:01):
So this 32 year-old young man is up there, and when his mother not present, attempts as she has really reliably since his break around 20 years old, so 12 or 13 years now, to put housing and case management and medication management services in place for him, there's a brief period in which he accepts them and then invariably quits them or blows them up or, you know, is unable to continue to participate because of his illness and his delusions. And it was helpful. The aunts, they're the aunts, right? Aunt said, the aunts said it was very helpful to think about the grieving, the loss of this idealized version of their nephew.
Kenneth Perlmutter, Ph.D. (36:59):
And by idealized, I don't mean grand version, I just mean, you know, kind of like middle of the road plus or minus one and a half standard deviations kind of kid development, you know? Maybe he struggles with this or that, you know, or you know, how to change high schools, you know, not just, fast track to Yale engineering. Yeah. But the whole, the whole wide highway.
Keith Sutton Psy.D. (37:22):
Yeah.
Kenneth Perlmutter, Ph.D. (37:25):
But a young man with schizophrenia is going to be off that highway by more than two standard deviations from the mean, right? And there is a real heartbreak associated with that, which many affixer parent is able to, I don't want to say deny, it sounds like, you know, kind of a frank attempt to avoid, but find some defense against the pain of that through the ongoing effort to provide the soothing and the serving and the reaching of the details. Yes.
Keith Sutton Psy.D. (38:03):
There's a hope where maybe there would be a more realistic acceptance of what is going on. And so that hope is maybe not helpful in that way because it's kind of trying to get them to create a situation that maybe is not necessarily possible. I've heard a nice metaphor with like kids with learning disabilities or so on, like the parent thought they were going on a vacation to, you know, Florida, they've got all their stuff for Florida and they end up in Minnesota in the winter. And, you know, being able to eventually accept that I'm here, I gotta make the best of this, get some warm clothes and so on, rather than just trying to kind of be as if we were in Florida and, and that kind of acceptance that we might be in this different place than we were expecting or hoping to be with our children, or who our children were going to , or how they were going to turn, and then instead accept that and actually get the gear to deal with that situation.
Kenneth Perlmutter, Ph.D. (38:57):
Yes. The way I would think about that is the hope is a defense against the despair.
Keith Sutton Psy.D. (39:03):
Yeah. It's protecting against the despair or the sadness, loss.
Kenneth Perlmutter, Ph.D. (39:08):
And that kind of segues nicely into another way that I help family members shift, and that's always the word shift, is to take a look at what holds them in the position they've occupied in vis-a-vis the dependency condition. Like, why do I keep doing this? Why did I send my son $200 by Western Union when he told me the drug dealers were going to beat him up if he didn't have the $200 later that day, I didn't believe him, but I couldn't not send it to him.
Keith Sutton Psy.D. (39:47):
Yeah.
Kenneth Perlmutter, Ph.D. (39:48):
Now is sending it to him wrong? In my model, no, it's neither right nor wrong. What would be wrong, would be to not wonder about the effects of sending it.
Keith Sutton Psy.D. (40:03):
Yeah.
Kenneth Perlmutter, Ph.D. (40:04):
And to not consider what my options or alternatives might be, if any. But I'll tell you, this is a real mom, when she told me: Kenneth, I knew he was probably going to buy drugs with it. And she was wiring it to Los Angeles from, from up here. But I also knew I wouldn't sleep a wink if I thought he was going to be taken and assaulted or beaten the way he described to me.
Keith Sutton Psy.D. (40:35):
Yeah.
Kenneth Perlmutter, Ph.D. (40:36):
So I paid $200 to get a night's sleep for my drug addict son who's going to use one way or another drugs, use drugs.
Keith Sutton Psy.D. (40:46):
Yeah.
Kenneth Perlmutter, Ph.D. (40:46):
Regardless of whether or not I send them the 200. And I never forgot that because you can meet many people in our field, or in especially in a chemical dependency related treatment, who would say, well, that's enabling. You can't do that. You know, and I'm not so persuaded that it's that black and white, especially if prescription equals parental misery.
Keith Sutton Psy.D. (41:09):
Well, it makes sense, right, of why the person's doing it. And sometimes I think about it as at least if we're avoiding or accommodating consciously, that we both know that this is maybe something that is right. Relieving the anxiety. It's not necessarily maybe the best potential for the kid, but at least you're doing it consciously and knowing that you're doing it for these reasons and kind of making that choice. Because then you can work with that kind of like you were saying that, if they're not aware or conscious of it, then, you know, and they're just reacting, bringing that to conscious.
Kenneth Perlmutter, Ph.D. (41:43):
Yes.
Keith Sutton Psy.D. (41:43):
And can help them make some of those decisions, which they may decide to keep on going with it because of the circumstance or the not being able to tolerate the fear of what might happen if I don't.
Kenneth Perlmutter, Ph.D. (41:59):
And with this particular mom, this is maybe 15-20 years ago, by the way, but it's quite salient because it really helps. We had done a good amount of work on the story that held her in the grip of the-- hostile dependency in which she was caught with her son. Because there's a small handful of these little narratives, I call them the lies that bind, that hold family members in the position they've been occupying in the dependency condition. And the most common one is I'm keeping her alive. And the parent believes that they must continue with whatever "S" behavior, serving, soothing, saving, smoothing, sacrificing, sobbing, solving that, you know, that they've been, that they've been demonstrating lest they lose this kid either to death or estrangement. Now, once we take a look at the power of that story, to hold the parent, and then identify the part of it that's distorted, thus the lie, the parent has a chance to move off it or for it to loosen its grip.
Keith Sutton Psy.D. (43:16):
Yeah.
Kenneth Perlmutter, Ph.D. (43:17):
So what do you think the lie might be in a parent's story? I'm keeping her alive, think simple.
Keith Sutton Psy.D. (43:25):
Did I have the ability? Like power? Like I'm not powerless. I can have an effect.
Kenneth Perlmutter, Ph.D. (43:33):
You're right. Exactly right. It's almost certainly not true that the parent can reliably keep this kid alive. Reliably, meaning 24/7, 365.
Keith Sutton Psy.D. (43:45):
Yeah.
Kenneth Perlmutter, Ph.D. (43:46):
And when we stumble on that, well, when we encounter this lie in the office, often when the kid's not there, I'll say, well, where is she right now? You know, to kind of make the point.
Keith Sutton Psy.D. (43:59):
Yeah, yeah. It makes me think about Lynn Lyons talks about, you know, how anxiety wants certainty. And so that seeking of certainty like, oh, if I do this, then I'll keep them alive. Or if I do this and feeling like I'm having some sort of control or ability or agency in this rather than being able to embrace the uncertainty of what will happen. And like you're pointing out like, where is she right now? You're uncertain.
Kenneth Perlmutter, Ph.D. (44:27):
That's a good lead into the next lie. Because I think, “I'm keeping her alive,” is more playing not to lose, right, “I'm going to do this to avoid this dreaded outcome,” which I don't minimize to them, you know, I say if you were to lose this kid, it would be a tragedy from which you would never fully recover. So it's not like, oh, well maybe, you know, I'm not sending any money because I can't keep her alive. So if she dies, oh well no, it's nothing resembling that. We're never that cavalier or even near it. But that's apparent, you know, kind of playing not to lose.
Kenneth Perlmutter, Ph.D. (45:09):
There's a more defensive condition like what you're talking about as an antidote for the anxiety, which I call If Only syndrome. And in this version, the parent keeps coming and usually trying to find resources and solutions. Solving is the most common If Only behavior. So it comes in two forms. Aspirational and regret. So there's, if only I find the right medicine therapist, weight loss program, weight gain program. You know, haircut, body suit as aesthetician school, for my kid, then all this will get better. And they might've been engaged in this research for years now by the time they meet me. But cost, it is a wonderful anxiety-binding activity. And so a parent will call me up 11 o'clock in the morning, describe the really stuck condition with their kid and how they recently enrolled them in PHP, IOP, DBT, CBT, whatever it might be, college of Marin, you know, college of Folklore.
Keith Sutton Psy.D. (46:33):
Sure.
Kenneth Perlmutter, Ph.D. (46:34):
How to be a, how to be a Luther, who, what do they call the guys that build guitars, whatever. And yet, you know it's not working. And so what do you think the most common answer is to the following question when I ask them, well, where is your son right now? 11 o'clock on a Tuesday, the mom's making phone calls. What do you think?
Keith Sutton Psy.D. (46:56):
I don't know, playing video games down in the room or something
Kenneth Perlmutter, Ph.D. (47:01):
Asleep. Yeah. Asleep down in their room --
Keith Sutton Psy.D. (47:02):
Oh, sleep. Yeah, yeah,
Kenneth Perlmutter, Ph.D. (47:04):
Asleep is the most common answer.
Keith Sutton Psy.D. (47:07):
Yeah.
Kenneth Perlmutter, Ph.D. (47:07):
So that illustrates it. Because there's the mom or the dad, you know, researching and trying to figure it out. Find the next thing --
Keith Sutton Psy.D. (47:16):
Working a lot harder than the kid.
Kenneth Perlmutter, Ph.D. (47:17):
Oh yeah. That's something we talk about a lot. Ratio of lifting effort definitely between the parent or the sibling. And once in a while these are the offspring and the parent is the one who's behaving in the more dependent fashion. Usually as a result of alcoholism or addiction more commonly. But sometimes a personality disorder.
Keith Sutton Psy.D. (47:40):
Yeah. And so you've got your book Freedom from Family Dysfunction, A Guide to Healing Families Battling Addiction or Mental Illness. And as we're getting going with our podcast today, you were saying you're doing some writing today. Do you have these ideas written down? Do you do trainings? How can folks --
Kenneth Perlmutter, Ph.D. (48:01):
Oh yeah. I've been training in this for many years, both at national level conferences and small group sessions that, you know, I've hosted or have been sponsored. There's nothing on the immediate horizon. But during COVID I offered an eight session, 75 minutes each CE. What'd that give you? 10 CEs, I think. Eight times one and a quarter is 10. 10 CE weekly Zoom thing, quite a few. All for clinicians, of course. I think we had a pretty good time. I think I offered it twice. Usually a group of about 12 people.
Keith Sutton Psy.D. (48:42):
Great.
Kenneth Perlmutter, Ph.D. (48:44):
My next book, and I was just talking to my publisher today, is called, the working title, is The Fixers Folly. How serving, soothing, saving and smoothing won't save you. Written specifically for that one member of the system who as I write more and more about fixers, who I've spent thousands of hours with and have more than one in my own family, maybe even could be accused of being one myself, in my own family. I've come to recognize that a lot of the fixing behavior is a defense that helps the fixer not know themselves.
Keith Sutton Psy.D. (49:25):
And so this is actually perfect. because I was interested in too, you had mentioned earlier thinking about how people are relating to each other and also how they're being seen or wanting to be seen. And you were talking about family, community, ancestors. Can you talk a little bit about that? About one's sense of self or being seen or their identity?
Kenneth Perlmutter, Ph.D. (49:52):
Yeah. So in my basic model, which is called the Model of stress induced and impaired coping and Wounded Family Systems, I believe every member has a version of stress induced impaired coping, regardless of their relative health in the world. And members occupy one of four roles. We have escapees who check out either emotionally, mentally, psychically, or physically. We have distractors who are the proof that we're fine, either they make the money or they have all the success. We have blamed ones or blamers who point the finger or take the blame, two sides of the same coin. And then we have fixers who come in the form of either directors, also known as controllers or martyrs. And often members assume a role because there's, you know, what organizational psychologists call role suction. Like there's a vacuum that role's available.
Keith Sutton Psy.D. (51:02):
Yeah. Yeah.
Kenneth Perlmutter, Ph.D. (51:03):
It also matches a valence they have, you know, a natural style. You're not going to turn a natural fixie into an escapee unless she gets so overwhelmed with her inability to fix that she starts using alcohol or benzodiazepines, then she can become an escapee. But people have a valence for one of these roles. And then the roles help them position themselves vis-a-vis each other with some contrast. Like, well, I'm not like her, I'm not like my brother. I'm not like dad. I don't tell everybody what to do. I'm not like mom, who just goes to her room and cries. I'm not like my, you know, other brother who's just like always in trouble. And so we help members take a look at what holds them in their role, what reinforces them in their role when, what they learned that that guides them to be in this role. When did they learn it? Usually very young. And I think I'm kind of answering right. I lost a little bit of the thread of the question
Keith Sutton Psy.D. (52:07):
No, it was about--
Kenneth Perlmutter, Ph.D. (52:08):
Oh, identity and self, right.
Keith Sutton Psy.D. (52:10):
Identity. And you were kind of saying it, it was coming after you're talking about counter transference, transference, how we relate, how we're seen by others, how we're wishing to be seen or presented ourselves.
Kenneth Perlmutter, Ph.D. (52:21):
It's a very powerful conversation in a family when there's a contrast as there often is between how the family behaves in order to maintain a certain reputation, position, or image in the community. And what's it actually like at home inside?
Keith Sutton Psy.D. (52:40):
Oh yeah, definitely.
Kenneth Perlmutter, Ph.D. (52:42):
Oh man. Yeah. And it's some of those--
Keith Sutton Psy.D. (52:44):
Well especially here in Marin where it's a, you know upper middle class or so on, or even very wealthy or so on, there's, I think more of presenting everything is perfect on the outside sometimes in that situation. And then coming home and, you know, the kids feeling like it's BS because we've got all this conflict or problems or the mom's drinking problem, but we're on the side acting like everything's perfect.
Kenneth Perlmutter, Ph.D. (53:08):
Yeah. You got it. Yeah. What's the, what's the image you would say your family tries to portray? And it starts with, you know, we are, we're, we are what? We're good Christians, we're well educated, we're wealthy, we're magnanimous, we're service oriented, we're academically successful, whatever it might be. Okay. And then what's it like actually at home?
Keith Sutton Psy.D. (53:32):
Yeah. Well, hey, Kenneth, this is all really wonderful and I really enjoyed the talk today. You've got so much great knowledge and information and we will put a link to your book. And also, yeah, looking forward to this next book coming out. Really appreciate this today, and thank you so much for taking the time.
Kenneth Perlmutter, Ph.D. (53:52):
I appreciate the opportunity, Keith. Thank you for having me.
Keith Sutton Psy.D. (53:55):
Great. Take care. Bye-Bye.
Kenneth Perlmutter, Ph.D. (53:56):
Bye.
Keith Sutton Psy.D. (53:58):
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton Psy.D. (01:35):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton Psy.D. (02:19):
Today I'll be speaking with Dr. Kenneth Perlmutter, who is the founder of the Family Recovery Institute and a licensed psychologist specializing in family systems. He has 35 years of experience working with complex psychological and behavioral health disorders. In 2008, he founded the Family Recovery Institute to provide multidisciplinary treatment for individuals and families, including dynamic therapy, family systems, work group therapies, healing workshops, and clinician training. He has pioneered and validated the Theory of Family System woundedness with a corresponding recovery model he calls stress induced impaired coping. He wrote the book, Freedom From Family Dysfunction, A Guide for Families Battling Addiction or Mental Illness, specifically for family members who love someone battling addiction or mental illness, but want to break the cycles of codependency and relapse plaguing their dysfunctional systems. He is overseeing the design and installation of the Family Treatment Program for Bayside Marin, Morningside Recovery, Safe Harbor Treatment Center for Women, Casa Capri, Windward Way, and other national level programs. In addition, he conducts a twice monthly therapy group for parents of troubled teens and stuck young adults and has historically conducted several healing workshops for families of the White Mound Apache Reservation in White River, Arizona. As a professional educator, he has served on the graduate faculty for San Francisco State University's counseling department, and as associate professor of Chemical Dependency Studies at Cal State East Bay. Let's listen to the interview.
Keith Sutton Psy.D. (03:48):
Well, hi, Kenneth. Welcome. Thanks for joining us.
Kenneth Perlmutter, Ph.D. (03:50):
Thanks a lot for having me, Keith.
Keith Sutton Psy.D. (03:52):
Yeah. So Kenneth, I know you. You're one of local here in Marin, in San Rafael as a therapist who does a lot of work with addiction, substance abuse. You work with families, you have your Family recovery institute. And so I wanted to learn more about the work that you're doing and particularly too around the family systemic work and, and addictions. But first I always like to find out about how people kind of got to doing what they're doing, their evolution of their thinking
Kenneth Perlmutter, Ph.D. (04:26):
Of my thinking or becoming a therapist, or both?
Keith Sutton Psy.D. (04:28):
Both. Yeah. What, wherever. Yeah.
Kenneth Perlmutter, Ph.D. (04:31):
Well, I was going to go to medical school and became persuaded. I was too scared of blood and needles.
Kenneth Perlmutter, Ph.D. (04:40):
I had poor guidance and would've been told, oh, half medical school students pass out during many of their initial procedures. We'll get you through it, but I didn't know that. So I switched to creative writing and journalism. because I was really strong in all that. And by the way, for any of you therapists working with parents who have kids that don't know what major, I highly recommend journalism as a major or a minor. It teaches you how to organize complex material, how to think, how to interview people, how to overcome social anxiety about introducing yourself. It was a great start.
Kenneth Perlmutter, Ph.D. (05:19):
And then I found myself in the world of San Francisco advertising in the eighties, which was a pretty wild ride in a lot of ways. And so I sought out a therapist who helped me a lot get through that, and I thought he had a pretty cool lifestyle and approach to things. And I thought maybe I could do that. That might be better. So I started going to graduate school at night, got a doctorate and a master's degree, not in that order. Still worked in advertising because I was pretty dependent on the income.
Kenneth Perlmutter, Ph.D. (05:55):
But in around 1989, I got an internship. I thought I was going to be a psychoanalyst because I really appreciated the down and in kind of thinking all the ideas about human development through the lens of the inner world. My school was very psychoanalytically oriented, and I got a practicum position and brand new therapist, first ever therapist position with what proved to be a very sophisticated agency that was psychoanalytically informed. It was called the Boyer House. And even though it was supposed to be a one academic year unpaid position, they hired me about halfway through that to work in the milieu, like as a counselor. And I ended up staying 14 years and becoming the clinical milieu director, the director of admissions, and similar.
Kenneth Perlmutter, Ph.D. (06:47):
So it was that first therapist, his name was Joe Riley in San Francisco in the eighties, who gave me the inspiration to want to move more into being a therapist. So in my second year, I'd say at, at Boyer House, I somehow got placed on the family therapy team, which I liked because the whole down and in three, four times a week, seeing one person, or seeing a small string of people that often, didn't seem to fire me up, as well as being in a room like with, you know, a dad and a mom and two teenagers and, you know, other family members perhaps. And the energy and the emotion and the challenge associated with engaging, you know, all those members endeavoring to appear and be neutral just really seemed to work a lot better for my personality and my thinking.
Kenneth Perlmutter, Ph.D. (07:52):
Though, I remained I don't know if you could say a devotee, and I am, to this day, my work is still heavily informed by psychoanalytic thinking, meaning thinking about the unconscious, the inner world, transference, countertransference and the nature of relating particularly therapist, client relating, therapist, family relating. And I help families look at how they relate to each other, of course, how they relate to their communities, like how they imagine they're seen or would like to be seen, how they relate to their ancestry, to their ancestors, you know, and how they picture those three ways of relating, informing their approach to the future and the present, of course. And so that's a big part of, that's an important way of thinking about how I think.
Kenneth Perlmutter, Ph.D. (08:59):
We do get thought of a lot at the Family Recovery Institute as being focused largely, or even primarily on substance use and addiction. And while we have a lot of expertise in that, including the personal recovery of quite a few of the staff members. I don't think of us as a substance abuse or addiction clinic. I think of us more as a full service mental health clinic with a lot of expertise in substance abuse and addiction recovery, trauma related disorders. And I might be jumping ahead, but we really specialize in working with families that have a member with more significant psychological or behavioral disturbance. And many therapists send me those families because they don't want to work with them. You know, like a narcissistic alcoholic father as an example. Or you know, a bipolar 30-year-old who's been creating havoc since high school in the family. And we'll work with individuals in the family, the family itself, any one member at the level of thinking about the family. But that's a way really for therapists to think about us. Think of Kenneth Perlmutter and his team for those more disturbed, more chaotic families, sometimes high conflict divorce. It's not a specialty, but we get a lot. And because we're a small team, we can divide and conquer a little bit, if you will. Like, the ideal package is, you should interrupt me, by the way, if I'm going-
Keith Sutton Psy.D. (10:53):
No, no, this is, yeah. Yeah. Keep going.
Kenneth Perlmutter, Ph.D. (10:56):
You know, the ideal package we would offer to someone, well, let me back up. Here's our most common referral. I got one last week. The mom calls, I have a 20-year-old son who's been away at college. And we just found out he went to no classes whatsoever his most recent semester. He lied about that. It was only when we happened to see a grade report or a letter about being on probation or something that we learned all this. He's been home now, what is it? October. He's been home now since the end of May. He smokes and uses cannabis pretty much daily. He was working for a time at Trader Joe's, Costco, Home Depot. Starbucks, whatever it might be. These are, I don't mean pejoratively in any way. But he, you know, was late too often and he lost the job, or he hated it and he quit. He doesn't want to go back to school. He didn't want to go back to school three weeks ago when it resumed at ASU, SMU, BU, SFSU, it doesn't matter where, right. And can you, can you straighten him out?
Keith Sutton Psy.D. (12:16):
Yeah. Okay, great. Well so there's two big pieces that I'm super interested in here that I'm thinking about. One particularly is the integration of kind of family therapy or family systems work and psychoanalytic. Because sometimes the, oftentimes, I know a lot of folks that are more, sometimes psychoanalytic or psychodynamic don't necessarily work as systemically because it can kind of affect the transference, the counter transference and kind of shift the frame of the therapy. So I'd love to hear about your kind of work within that or your influences in that kind of working systemically and analytically.
Kenneth Perlmutter, Ph.D. (13:00):
Well, that's a really important observation that you're making. So there isn't an effort, per se, in the family systems work to maintain a pure kind of tableau rasa projective screen onto the therapist, as you would find in a more traditionally psychoanalytically informed psychotherapy. Rather, I use my psychoanalytic training and some of the concepts to help me think about attachment, the nature of attachment, the stage of family development in which the family presents, you know, that they're occupying at the time. And in that way, it's a psychoanalytically informed systemic work. But it probably draws more directly on my own personal experience with my own family since 1989, my own wounded family system, and how it has functioned or dysfunctioned. Attachment theory systems notions, like what is a system? How does a system function? How do members influence the system? How do we affect each other? What do we need from each other? How are crises managed? What's the nature of privacy? So I think to call it psychoanalytic family work wouldn't be very accurate. Though, there is a strong movement for psychoanalytically informed or psychoanalytic couples work. In fact, there's an organization in the Bay Area that specializes in it, PCPG, Psychoanalytic Couples Psychotherapy Group, and they offer trainings as well.
Keith Sutton Psy.D. (14:56):
Great
Kenneth Perlmutter, Ph.D. (14:57):
Intensive training in couple work that's psychoanalytically. Yeah. That is psychoanalytic.
Keith Sutton Psy.D. (15:05):
Nice. And tell me a little bit about the family development and where they are in their developmental period. Is that more like state kind of a lifecycle kind of-
Kenneth Perlmutter, Ph.D. (15:20):
That's probably a, yeah, that's probably a fair way to think about it.
Keith Sutton Psy.D. (15:23):
Yeah. Like whether, you know, young children or adolescent or, you know, kind of empty nest, like those kind of stages.
Kenneth Perlmutter, Ph.D. (15:31):
Yes, exactly.
Keith Sutton Psy.D. (15:33):
Got it.
Kenneth Perlmutter, Ph.D. (15:34):
Yeah. Exactly. Because, you know the the nature of intervention and solution for, you know, parents who had not long ago of, you know, an oppositional and very intelligent 12-year-old or 11-year-old who has a superstar, 13-year-old older sibling, are going to be, it's a very different kind of conversation and set of interventions, than let's say for parents approaching 60 who have a 35-year-old, you know, highly problematic dependent child -- adult child.
Keith Sutton Psy.D. (16:16):
Sure. Definitely. Yeah. Now look-
Kenneth Perlmutter, Ph.D. (16:21):
Can I say one more thing about, a lot of the work looks at the nature of dependency in the system, and I don't mean chemical dependency, though that's not ignored when it's part of the deal, but I see families that experience dependency, and I wrote a lot about this in my book that can be described in one of three forms. So families come with problematic offspring, that's what we call them problematic offspring. Because that covers all genders, all diagnoses.
Keith Sutton Psy.D. (16:56):
Yeah.
Kenneth Perlmutter, Ph.D. (16:57):
You know, and everything in between. So we have exaggerated dependency, we have hostile dependency, and there's chronic dependency. And probably the most common form is the exaggerated dependency, which basically is kind of what it connotes a situation where a child of any age, depends on the parents or expects the parents and the parents comply to provide things and do things for that child. And I'm just going to say child. I've had four or five families where the kid is in their fifties. Not common. Typically, the kids are 16 to 30 or a little older typically, in which the parents have been performing functions and fulfilling needs of the child that the child could fulfill for themselves. And as a result of this exaggerated dependency, everyone gets caught that much deeper in this kind of systemic goo that keeps members stuck and keeps parents believing that they have to provide these things, lest there be some calamity or catastrophe that they couldn't bear.
Keith Sutton Psy.D. (18:19):
Yeah.
Kenneth Perlmutter, Ph.D. (18:20):
And it works very well for the kids who are caught in exaggerated dependency for their parents to believe, well, we can't just cut him off. Although for the record, we never advocate cutting anyone off. Or anything like so-called tough love.
Keith Sutton Psy.D. (18:35):
Yeah.
Kenneth Perlmutter, Ph.D. (18:37):
But this is probably the most common form.
Keith Sutton Psy.D. (18:39):
So it's kind of like sometimes what people talk about as sometimes that enmeshment or an, you know, enabling that might be happening.
Kenneth Perlmutter, Ph.D. (18:46):
Yeah. I think enabling
Keith Sutton Psy.D. (18:47):
As trying to support their children and care for their children. But sometimes, yeah, the anxiety leads to, you know, over accommodation and reinforcing avoidance and potentially enabling in as a byproduct.
Kenneth Perlmutter, Ph.D. (19:00):
Yeah. It's probably more enabling than the former term term that you used
Keith Sutton Psy.D. (19:05):
Rather than enmeshed.
Kenneth Perlmutter, Ph.D. (19:06):
Yeah. I think of enmeshment as more an emotional condition, which you can have with or without the enable. Though I think probably you know, the syllogism would be all enablers are enmeshed. Yeah.
Keith Sutton Psy.D. (19:22):
Okay.
Kenneth Perlmutter, Ph.D. (19:23):
We talk about enabling in its most destructive form, is that which is unconscious. Meaning it's not really thought about. The parent doesn't wonder, well, what would be the, what's the effect of my providing this again on me? That's the last question they'll ask me--the parent, on my kid or on the system. Right. Yeah. And what's the effect of me providing this, again, on the nature of dependency in the system? And once I help people start to just wonder that, like, we never tell people, don't give them any more money or, you know, don't let 'em use the car or, you know, cut them off or change the locks or anything like that. Though at times, parents do the work and they conclude we can no longer live together in a way that supports our parental serenity, safety, security, or quality of life.
Keith Sutton Psy.D. (20:26):
Yeah.
Kenneth Perlmutter, Ph.D. (20:27):
What's true in most families is that when the parents show up for help and the kid can be anywhere from 15 to 50, they have not placed sufficient emphasis on their own needs. It's kind of like classic codependency, if you will. Thinking of the effect on me comes last.
Keith Sutton Psy.D. (20:50):
Yeah. That kind of sacrificing and just trying to help the kids or do something, you know, to take care of the kids, but not necessarily consciously thinking about is this really helping them in the long run, and is this helping me or is this really kind of for benefit of our long-term health.
Kenneth Perlmutter, Ph.D. (21:09):
Well, sometimes the evidence is in, and it's pretty patent that I, the parent, am not going to be able to, certainly not going to be able to change my kid. Most parents come expecting or, or having, attempted to get relief for themselves by changing their kid. . Or their kid's behavior, or their kid's beliefs or their kid's attitudes. And usually by the time the kid is 20, 25, 30, 35, 40, the evidence is irrefutable that the parents are not going to be able to change the kid. So we immediately start talking about pursuing solutions for the parents that are not conditional on the kid being different, though again, without anything like, kick him out, you are dead to me or any other similar, you know, Robert De Niro-esque kind of drama.
Keith Sutton Psy.D. (22:04):
Yeah. So, so shifting their focus away from like, change my kid, or what can I do to change my kid to what can we do to help change your situation?
Kenneth Perlmutter, Ph.D. (22:15):
Our situation, yes.
Keith Sutton Psy.D. (22:17):
Our situation
Kenneth Perlmutter, Ph.D. (22:18):
And in my method, which I've been practicing a long time now, of all the things parents can do to attempt to change their kid when they make the shift, the hierarchical emphasis toward their own needs as the parents, they create the conditions under which it's most likely their kid will move more in the direction they've always wanted. It's a bit paradoxical, but I see it. Over and over and over and over and over. And again, this is not tough love, this is not. Tough love equals tough stake and equals parental misery.
Keith Sutton Psy.D. (22:56):
Sure. Tell me a little bit about some examples of that, as you're kind of helping them shift in that hierarchy or shift their focus. What does that look like and how, because I know that, you know, oftentimes I think that sometimes as people try to encourage parents, for example, to do self-care or something the parent's like, yeah, yeah. You know, when the kid's like out of the house, I will. But right now, like their so focused is on the kids and kind of, you know, really pushing their needs aside. What does that look like? And I know it's probably also different in this situation where they're after 18 or so on and have expected maybe to have been launched, but they're not.
Keith Sutton Psy.D. (23:38):
And I also really want to point out that it's great that you are working with the families over 18, because I think a lot of people get stuck in, oh, this kid's over 18, so I can't do any of the family work. But ultimately that's where so much of the power is, especially like this situation you're talking about. I oftentimes get that too. Yeah. Bombed outta school, home smoking weed, playing video games until five in the morning. You know, maybe they're taking a class or two at community college, but they show up half the time and keep dropping all their classes. And as parents, you know, that, they can still also be helpful and, and sometimes they're unknowingly, like you're saying, kind of enabling in a way that's not necessarily helping support with the kids' success, but really, oftentimes the parents are the key to helping create that shift. Sometimes the kids are so depressed or just doing so much, smoking weed or whatever it might be that they're not really that motivated for change,
Kenneth Perlmutter, Ph.D. (24:37):
Especially if you have your parents, you know, taking care of most of the things you need. What would be the motivator to change? There might be some internal motivation.
Keith Sutton Psy.D. (24:47):
Yeah. But especially if they're in patterns of avoidance where they're just like not wanting to deal with
Kenneth Perlmutter, Ph.D. (24:52):
Yeah. That's a good way to say it.
Keith Sutton Psy.D. (24:53):
Right. And they're just like, so, yeah. So back to this idea of kind of shifting the parents with their focus on their needs and kind of prioritizing their place in the hierarchy of the family system. What does that look like, or how are parents reacting to that as you're encouraging them to do that?
Kenneth Perlmutter, Ph.D. (25:12):
Tentatively, is how they react to that. I think the most common approach in that regard, is to help a parent identify their own, their behaviors, that reinforce or continue the conditioning of the exaggerated dependency. And so before I jump to that, let me just describe another common form of the dependency which is what we call hostile dependency. And, again, it's kind of what you would think it connotes. In hostile dependency, the child depends on the parents and is also assaultive to the system. Let's say, he may be belligerent, he may steal, he will put at risk the family's resources or squander them, and or reputation. And it can be as blatant, you know, and as frightening as physical violence in the home, throwing things, breaking things, verbally assaulting his parents, or her siblings, or I guess self-harm can maybe come in this category, but it doesn't fit as tightly.
Kenneth Perlmutter, Ph.D. (26:37):
And so we start there with an examination of how the parents respond to the hostility, because in the method, kind of in a DBT sort of way, we place assaults on the family system or on any of its members. At the top of the hierarchy in terms of what requires intervention. Kind of like a DBT client calls her therapist during the week because she's going to cut herself and has helped with a tool and avoids cutting, comes in for session and wants to talk about a boy she met on Bart. And the DBT therapist will say, well, we could talk about this kid, Aaron, you met on Bart, but first we need to talk a little bit about the phone call we had the other day when you were thinking very seriously about cutting yourself again.
Kenneth Perlmutter, Ph.D. (27:34):
So in hostile dependency, we look at the parents' behaviors that basically tolerate the hostility and make it possible for it to continue. And all these parental behaviors, or even it can be sibling behaviors too, are probably caught up in one of the following actions. And you don't know me that well, but I like alliteration. They all start with letter S.
Keith Sutton Psy.D. (28:09):
Okay.
Kenneth Perlmutter, Ph.D. (28:10):
So we have serving, soothing, saving, smoothing, solving, sacrificing, sobbing. You know, that probably will, can always come up with a few more when we rattle off the list.
Keith Sutton Psy.D. (28:28):
Sure.
Kenneth Perlmutter, Ph.D. (28:28):
When-- so, I help a parent identify which of these, you know, they most common events, you know, do you tend to like, try to, you know, make him feel better? Do you anticipate your kids' needs and attempt to serve them? Do you smooth over the details of their lives by reminding them of appointments? Some of these aren't wrong. Don't, I'm just spitballing here.
Keith Sutton Psy.D. (28:56):
Sure, sure.
Kenneth Perlmutter, Ph.D. (28:57):
You know calling their bosses for them, you know, what do you give up in order to provide for your kid? That would be the sacrificing, you know, how caught are you in solving, you know, the bigger questions in their life. And once we get a shorter list of a particular family's behavioral patterns, then we would intervene gently on those. Often with a question like, well, tell me your idea, your fantasy of what would happen if you didn't do that. Like for five minutes, even.
Keith Sutton Psy.D. (29:40):
Ah, yeah.
Kenneth Perlmutter, Ph.D. (29:42):
Seriously. Sometimes it comes down to that.
Keith Sutton Psy.D. (29:45):
And is this conversation with the child or young adult present, or is this with the parents separately, or does it-
Kenneth Perlmutter, Ph.D. (29:52):
That's a great question. Typically I start with just the parents. But I say to them, if you all are ready to talk together from the get go, and just this morning a dad said, I suggested the parents come in, one of them couldn't make the time, the dad said, I'm just going to come with our son or daughter. I don't even remember. And I, I had already told them, you know, because they wanted to come in together. I said, if you know you're ready to start talking together, that's fine. I would probably, in any case, split them up some of the time. I definitely like meeting with the kids in addition to meeting with the parents, and when there's an IP, everybody knows what that is, in the kid group, I always try to make it that I meet with the parents and then I meet with all the kids. So that they're to reduce the whole IP focus.
Keith Sutton Psy.D. (30:56):
Yeah. The identity patient. Yeah.
Kenneth Perlmutter, Ph.D. (30:57):
Yeah. Sorry, I should've defined it. Yes. Right. Because I tell them this is not a forum for straightening out Jimmy or Jessica. Sure. The forum for looking at how our system functions, how we each are participating in the deal with each other. And to talk about what we know we want more of or less of from each other and for ourselves in our lives as members of this family.
Keith Sutton Psy.D. (31:24):
Yeah.
Kenneth Perlmutter, Ph.D. (31:25):
That helps a lot with the IP because they're so used to, you know, coming in with their parents and then dad rattles off the list of medications since he was 12 . And mom talks about all the heartbreak she's experienced, you know, and the kid watches and listens or doesn't and sits there and it's just more of the same. Yeah. So I do a lot of work to try to have a different kind of conversation than the one they've had in the past with other therapists.
Keith Sutton Psy.D. (31:58):
Sure.
Kenneth Perlmutter, Ph.D. (31:58):
Or, and certainly with each other, but a lot of what I'm saying to you today. I would say in the kids' presence. Yeah. I think virtually everything that I've said today, I would say. Depending on, you know, the kid's willingness to just comport themselves in a way so that we could have a conversation. Yeah.
Keith Sutton Psy.D. (32:19):
Yeah. Definitely. Okay. So, and this is this piece about kind of shifting again, the hierarchy, kind of the parents you know, looking at their needs, I guess. And then particularly in this case, in the assaultive kind of dependent situation, really kind of prioritizing, you know, addressing those issues. And you're going through these serving, soothing, saving, solving, sacrificing, sobbing and so on, to really kind of look at how they might be engaging in this, and then you're kind of having them be curious around it. And just really bringing that more to consciousness and also potentially shifting that. And that's kind of more of the way of going towards the parents' needs.
Kenneth Perlmutter, Ph.D. (33:09):
Yeah.
Keith Sutton Psy.D. (33:09):
Of basically engaging in that lesson and being able to do, I guess other things or so on or not be so caught up in, in trying to save or solving or so on.
Kenneth Perlmutter, Ph.D. (33:23):
What would it be like to conclude you aren't able to solve and serve and smooth for your kid? What's in the way of recognizing that the data of your lives adds up to that?
Keith Sutton Psy.D. (33:41):
Yeah.
Kenneth Perlmutter, Ph.D. (33:41):
But really asking that, not, you know, as a rhetorical question. Like, what the hell's wrong with you? Why can't you just see and face it? But really instead, like, what would that mean? Because it usually means a lot of grief.
Keith Sutton Psy.D. (33:55):
Yeah.
Kenneth Perlmutter, Ph.D. (33:56):
Parents have lost the idealized version or vision of their kid that they had, you know, from kindergarten. And many, many of my kids, we could call them, are on paths that have diverged dramatically from, you know, kindergarten to middle school to high school graduation, to college, to some kind of, some version of independent living.
Keith Sutton Psy.D. (34:26):
Yeah.
Kenneth Perlmutter, Ph.D. (34:26):
And sometimes that divergence is dramatic and kind of heartbreaking.
Keith Sutton Psy.D. (34:32):
Yeah.
Kenneth Perlmutter, Ph.D. (34:33):
And we honor that. And once we make room for a little bit of that grieving, family members may find it easier to make some shifts in their own behavior.
Keith Sutton Psy.D. (34:47):
Sure.
Kenneth Perlmutter, Ph.D. (34:49):
Because after all, isn't that what we can control more than anything else, is like what we do?
Keith Sutton Psy.D. (34:53):
Yeah. Our side of the street. Right?
Kenneth Perlmutter, Ph.D. (34:54):
Yeah.
Keith Sutton Psy.D. (34:55):
Yeah. Definitely. Now do you want to speak a little bit about the chronic dependent position?
Kenneth Perlmutter, Ph.D. (35:02):
Yeah. Okay. So the third form is chronic dependency, and that's where, you know, your kid of any age has a, you know, maybe lifelong or long lasting mental illness or learning disability or some other kind of impairment, that we have to find some acceptance for, and then titrate the caregiving and the sacrificing that we do for that person that recognizes and matches their chronicity, if you will. You know, I was just meeting with two sisters who have a third sister, who has a 32 year-old son with pretty significant, pretty severe schizophrenia. And for those of you familiar, which is most therapists, schizophrenia is just a heartbreaking, tragic illness, especially in its more severe forms.
Kenneth Perlmutter, Ph.D. (36:01):
So this 32 year-old young man is up there, and when his mother not present, attempts as she has really reliably since his break around 20 years old, so 12 or 13 years now, to put housing and case management and medication management services in place for him, there's a brief period in which he accepts them and then invariably quits them or blows them up or, you know, is unable to continue to participate because of his illness and his delusions. And it was helpful. The aunts, they're the aunts, right? Aunt said, the aunts said it was very helpful to think about the grieving, the loss of this idealized version of their nephew.
Kenneth Perlmutter, Ph.D. (36:59):
And by idealized, I don't mean grand version, I just mean, you know, kind of like middle of the road plus or minus one and a half standard deviations kind of kid development, you know? Maybe he struggles with this or that, you know, or you know, how to change high schools, you know, not just, fast track to Yale engineering. Yeah. But the whole, the whole wide highway.
Keith Sutton Psy.D. (37:22):
Yeah.
Kenneth Perlmutter, Ph.D. (37:25):
But a young man with schizophrenia is going to be off that highway by more than two standard deviations from the mean, right? And there is a real heartbreak associated with that, which many affixer parent is able to, I don't want to say deny, it sounds like, you know, kind of a frank attempt to avoid, but find some defense against the pain of that through the ongoing effort to provide the soothing and the serving and the reaching of the details. Yes.
Keith Sutton Psy.D. (38:03):
There's a hope where maybe there would be a more realistic acceptance of what is going on. And so that hope is maybe not helpful in that way because it's kind of trying to get them to create a situation that maybe is not necessarily possible. I've heard a nice metaphor with like kids with learning disabilities or so on, like the parent thought they were going on a vacation to, you know, Florida, they've got all their stuff for Florida and they end up in Minnesota in the winter. And, you know, being able to eventually accept that I'm here, I gotta make the best of this, get some warm clothes and so on, rather than just trying to kind of be as if we were in Florida and, and that kind of acceptance that we might be in this different place than we were expecting or hoping to be with our children, or who our children were going to , or how they were going to turn, and then instead accept that and actually get the gear to deal with that situation.
Kenneth Perlmutter, Ph.D. (38:57):
Yes. The way I would think about that is the hope is a defense against the despair.
Keith Sutton Psy.D. (39:03):
Yeah. It's protecting against the despair or the sadness, loss.
Kenneth Perlmutter, Ph.D. (39:08):
And that kind of segues nicely into another way that I help family members shift, and that's always the word shift, is to take a look at what holds them in the position they've occupied in vis-a-vis the dependency condition. Like, why do I keep doing this? Why did I send my son $200 by Western Union when he told me the drug dealers were going to beat him up if he didn't have the $200 later that day, I didn't believe him, but I couldn't not send it to him.
Keith Sutton Psy.D. (39:47):
Yeah.
Kenneth Perlmutter, Ph.D. (39:48):
Now is sending it to him wrong? In my model, no, it's neither right nor wrong. What would be wrong, would be to not wonder about the effects of sending it.
Keith Sutton Psy.D. (40:03):
Yeah.
Kenneth Perlmutter, Ph.D. (40:04):
And to not consider what my options or alternatives might be, if any. But I'll tell you, this is a real mom, when she told me: Kenneth, I knew he was probably going to buy drugs with it. And she was wiring it to Los Angeles from, from up here. But I also knew I wouldn't sleep a wink if I thought he was going to be taken and assaulted or beaten the way he described to me.
Keith Sutton Psy.D. (40:35):
Yeah.
Kenneth Perlmutter, Ph.D. (40:36):
So I paid $200 to get a night's sleep for my drug addict son who's going to use one way or another drugs, use drugs.
Keith Sutton Psy.D. (40:46):
Yeah.
Kenneth Perlmutter, Ph.D. (40:46):
Regardless of whether or not I send them the 200. And I never forgot that because you can meet many people in our field, or in especially in a chemical dependency related treatment, who would say, well, that's enabling. You can't do that. You know, and I'm not so persuaded that it's that black and white, especially if prescription equals parental misery.
Keith Sutton Psy.D. (41:09):
Well, it makes sense, right, of why the person's doing it. And sometimes I think about it as at least if we're avoiding or accommodating consciously, that we both know that this is maybe something that is right. Relieving the anxiety. It's not necessarily maybe the best potential for the kid, but at least you're doing it consciously and knowing that you're doing it for these reasons and kind of making that choice. Because then you can work with that kind of like you were saying that, if they're not aware or conscious of it, then, you know, and they're just reacting, bringing that to conscious.
Kenneth Perlmutter, Ph.D. (41:43):
Yes.
Keith Sutton Psy.D. (41:43):
And can help them make some of those decisions, which they may decide to keep on going with it because of the circumstance or the not being able to tolerate the fear of what might happen if I don't.
Kenneth Perlmutter, Ph.D. (41:59):
And with this particular mom, this is maybe 15-20 years ago, by the way, but it's quite salient because it really helps. We had done a good amount of work on the story that held her in the grip of the-- hostile dependency in which she was caught with her son. Because there's a small handful of these little narratives, I call them the lies that bind, that hold family members in the position they've been occupying in the dependency condition. And the most common one is I'm keeping her alive. And the parent believes that they must continue with whatever "S" behavior, serving, soothing, saving, smoothing, sacrificing, sobbing, solving that, you know, that they've been, that they've been demonstrating lest they lose this kid either to death or estrangement. Now, once we take a look at the power of that story, to hold the parent, and then identify the part of it that's distorted, thus the lie, the parent has a chance to move off it or for it to loosen its grip.
Keith Sutton Psy.D. (43:16):
Yeah.
Kenneth Perlmutter, Ph.D. (43:17):
So what do you think the lie might be in a parent's story? I'm keeping her alive, think simple.
Keith Sutton Psy.D. (43:25):
Did I have the ability? Like power? Like I'm not powerless. I can have an effect.
Kenneth Perlmutter, Ph.D. (43:33):
You're right. Exactly right. It's almost certainly not true that the parent can reliably keep this kid alive. Reliably, meaning 24/7, 365.
Keith Sutton Psy.D. (43:45):
Yeah.
Kenneth Perlmutter, Ph.D. (43:46):
And when we stumble on that, well, when we encounter this lie in the office, often when the kid's not there, I'll say, well, where is she right now? You know, to kind of make the point.
Keith Sutton Psy.D. (43:59):
Yeah, yeah. It makes me think about Lynn Lyons talks about, you know, how anxiety wants certainty. And so that seeking of certainty like, oh, if I do this, then I'll keep them alive. Or if I do this and feeling like I'm having some sort of control or ability or agency in this rather than being able to embrace the uncertainty of what will happen. And like you're pointing out like, where is she right now? You're uncertain.
Kenneth Perlmutter, Ph.D. (44:27):
That's a good lead into the next lie. Because I think, “I'm keeping her alive,” is more playing not to lose, right, “I'm going to do this to avoid this dreaded outcome,” which I don't minimize to them, you know, I say if you were to lose this kid, it would be a tragedy from which you would never fully recover. So it's not like, oh, well maybe, you know, I'm not sending any money because I can't keep her alive. So if she dies, oh well no, it's nothing resembling that. We're never that cavalier or even near it. But that's apparent, you know, kind of playing not to lose.
Kenneth Perlmutter, Ph.D. (45:09):
There's a more defensive condition like what you're talking about as an antidote for the anxiety, which I call If Only syndrome. And in this version, the parent keeps coming and usually trying to find resources and solutions. Solving is the most common If Only behavior. So it comes in two forms. Aspirational and regret. So there's, if only I find the right medicine therapist, weight loss program, weight gain program. You know, haircut, body suit as aesthetician school, for my kid, then all this will get better. And they might've been engaged in this research for years now by the time they meet me. But cost, it is a wonderful anxiety-binding activity. And so a parent will call me up 11 o'clock in the morning, describe the really stuck condition with their kid and how they recently enrolled them in PHP, IOP, DBT, CBT, whatever it might be, college of Marin, you know, college of Folklore.
Keith Sutton Psy.D. (46:33):
Sure.
Kenneth Perlmutter, Ph.D. (46:34):
How to be a, how to be a Luther, who, what do they call the guys that build guitars, whatever. And yet, you know it's not working. And so what do you think the most common answer is to the following question when I ask them, well, where is your son right now? 11 o'clock on a Tuesday, the mom's making phone calls. What do you think?
Keith Sutton Psy.D. (46:56):
I don't know, playing video games down in the room or something
Kenneth Perlmutter, Ph.D. (47:01):
Asleep. Yeah. Asleep down in their room --
Keith Sutton Psy.D. (47:02):
Oh, sleep. Yeah, yeah,
Kenneth Perlmutter, Ph.D. (47:04):
Asleep is the most common answer.
Keith Sutton Psy.D. (47:07):
Yeah.
Kenneth Perlmutter, Ph.D. (47:07):
So that illustrates it. Because there's the mom or the dad, you know, researching and trying to figure it out. Find the next thing --
Keith Sutton Psy.D. (47:16):
Working a lot harder than the kid.
Kenneth Perlmutter, Ph.D. (47:17):
Oh yeah. That's something we talk about a lot. Ratio of lifting effort definitely between the parent or the sibling. And once in a while these are the offspring and the parent is the one who's behaving in the more dependent fashion. Usually as a result of alcoholism or addiction more commonly. But sometimes a personality disorder.
Keith Sutton Psy.D. (47:40):
Yeah. And so you've got your book Freedom from Family Dysfunction, A Guide to Healing Families Battling Addiction or Mental Illness. And as we're getting going with our podcast today, you were saying you're doing some writing today. Do you have these ideas written down? Do you do trainings? How can folks --
Kenneth Perlmutter, Ph.D. (48:01):
Oh yeah. I've been training in this for many years, both at national level conferences and small group sessions that, you know, I've hosted or have been sponsored. There's nothing on the immediate horizon. But during COVID I offered an eight session, 75 minutes each CE. What'd that give you? 10 CEs, I think. Eight times one and a quarter is 10. 10 CE weekly Zoom thing, quite a few. All for clinicians, of course. I think we had a pretty good time. I think I offered it twice. Usually a group of about 12 people.
Keith Sutton Psy.D. (48:42):
Great.
Kenneth Perlmutter, Ph.D. (48:44):
My next book, and I was just talking to my publisher today, is called, the working title, is The Fixers Folly. How serving, soothing, saving and smoothing won't save you. Written specifically for that one member of the system who as I write more and more about fixers, who I've spent thousands of hours with and have more than one in my own family, maybe even could be accused of being one myself, in my own family. I've come to recognize that a lot of the fixing behavior is a defense that helps the fixer not know themselves.
Keith Sutton Psy.D. (49:25):
And so this is actually perfect. because I was interested in too, you had mentioned earlier thinking about how people are relating to each other and also how they're being seen or wanting to be seen. And you were talking about family, community, ancestors. Can you talk a little bit about that? About one's sense of self or being seen or their identity?
Kenneth Perlmutter, Ph.D. (49:52):
Yeah. So in my basic model, which is called the Model of stress induced and impaired coping and Wounded Family Systems, I believe every member has a version of stress induced impaired coping, regardless of their relative health in the world. And members occupy one of four roles. We have escapees who check out either emotionally, mentally, psychically, or physically. We have distractors who are the proof that we're fine, either they make the money or they have all the success. We have blamed ones or blamers who point the finger or take the blame, two sides of the same coin. And then we have fixers who come in the form of either directors, also known as controllers or martyrs. And often members assume a role because there's, you know, what organizational psychologists call role suction. Like there's a vacuum that role's available.
Keith Sutton Psy.D. (51:02):
Yeah. Yeah.
Kenneth Perlmutter, Ph.D. (51:03):
It also matches a valence they have, you know, a natural style. You're not going to turn a natural fixie into an escapee unless she gets so overwhelmed with her inability to fix that she starts using alcohol or benzodiazepines, then she can become an escapee. But people have a valence for one of these roles. And then the roles help them position themselves vis-a-vis each other with some contrast. Like, well, I'm not like her, I'm not like my brother. I'm not like dad. I don't tell everybody what to do. I'm not like mom, who just goes to her room and cries. I'm not like my, you know, other brother who's just like always in trouble. And so we help members take a look at what holds them in their role, what reinforces them in their role when, what they learned that that guides them to be in this role. When did they learn it? Usually very young. And I think I'm kind of answering right. I lost a little bit of the thread of the question
Keith Sutton Psy.D. (52:07):
No, it was about--
Kenneth Perlmutter, Ph.D. (52:08):
Oh, identity and self, right.
Keith Sutton Psy.D. (52:10):
Identity. And you were kind of saying it, it was coming after you're talking about counter transference, transference, how we relate, how we're seen by others, how we're wishing to be seen or presented ourselves.
Kenneth Perlmutter, Ph.D. (52:21):
It's a very powerful conversation in a family when there's a contrast as there often is between how the family behaves in order to maintain a certain reputation, position, or image in the community. And what's it actually like at home inside?
Keith Sutton Psy.D. (52:40):
Oh yeah, definitely.
Kenneth Perlmutter, Ph.D. (52:42):
Oh man. Yeah. And it's some of those--
Keith Sutton Psy.D. (52:44):
Well especially here in Marin where it's a, you know upper middle class or so on, or even very wealthy or so on, there's, I think more of presenting everything is perfect on the outside sometimes in that situation. And then coming home and, you know, the kids feeling like it's BS because we've got all this conflict or problems or the mom's drinking problem, but we're on the side acting like everything's perfect.
Kenneth Perlmutter, Ph.D. (53:08):
Yeah. You got it. Yeah. What's the, what's the image you would say your family tries to portray? And it starts with, you know, we are, we're, we are what? We're good Christians, we're well educated, we're wealthy, we're magnanimous, we're service oriented, we're academically successful, whatever it might be. Okay. And then what's it like actually at home?
Keith Sutton Psy.D. (53:32):
Yeah. Well, hey, Kenneth, this is all really wonderful and I really enjoyed the talk today. You've got so much great knowledge and information and we will put a link to your book. And also, yeah, looking forward to this next book coming out. Really appreciate this today, and thank you so much for taking the time.
Kenneth Perlmutter, Ph.D. (53:52):
I appreciate the opportunity, Keith. Thank you for having me.
Keith Sutton Psy.D. (53:55):
Great. Take care. Bye-Bye.
Kenneth Perlmutter, Ph.D. (53:56):
Bye.
Keith Sutton Psy.D. (53:58):
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